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Multicenter Study

Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: 'establishing normal and reference values'

Reference Values for Arterial Stiffness' Collaboration. Eur Heart J. 2010 Oct.

Abstract

Aims: Carotid-femoral pulse wave velocity (PWV), a direct measure of aortic stiffness, has become increasingly important for total cardiovascular (CV) risk estimation. Its application as a routine tool for clinical patient evaluation has been hampered by the absence of reference values. The aim of the present study is to establish reference and normal values for PWV based on a large European population.

Methods and results: We gathered data from 16 867 subjects and patients from 13 different centres across eight European countries, in which PWV and basic clinical parameters were measured. Of these, 11 092 individuals were free from overt CV disease, non-diabetic and untreated by either anti-hypertensive or lipid-lowering drugs and constituted the reference value population, of which the subset with optimal/normal blood pressures (BPs) (n = 1455) is the normal value population. Prior to data pooling, PWV values were converted to a common standard using established conversion formulae. Subjects were categorized by age decade and further subdivided according to BP categories. Pulse wave velocity increased with age and BP category; the increase with age being more pronounced for higher BP categories and the increase with BP being more important for older subjects. The distribution of PWV with age and BP category is described and reference values for PWV are established. Normal values are proposed based on the PWV values observed in the non-hypertensive subpopulation who had no additional CV risk factors.

Conclusion: The present study is the first to establish reference and normal values for PWV, combining a sizeable European population after standardizing results for different methods of PWV measurement.

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Figures

Figure 1
Figure 1
Flowchart describing the selection and categorization of subjects from the reference value database for the present analysis. PWV, pulse wave velocity; CVD, cardiovascular disease; BP, blood pressure.
Figure 2
Figure 2
Normal values for pulse wave velocity: average according to age (1455 subjects). Boxes contain 50% of the data and bars contain the remainder; horizontal lines indicate medians and the circle indicates outliers.
Figure 3
Figure 3
Reference values for pulse wave velocity (PWV): mean values according to age and blood pressure (BP) categories (11 092 subjects). HT, hypertension.
Figure 4
Figure 4
(Top) Pulse wave velocity (PWV) vs. age in the reference value population (11 092 subjects). Regression lines denote the results of regression on age2 for different blood pressure (BP) categories. (Bottom) Pulse wave velocity vs. mean blood pressure (MBP) in the reference value population (11 092 subjects). Regression lines denote the results of linear regression on mean blood pressure for different age categories. HT, hypertension; BP, blood pressure.
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